Clinical Characteristics And Risk Factors Of Death In Patients With Community-acquired Pneumonia Sepsis

Objective: To investigate the clinical characteristics and death risk factors of patients with community acquired pneumonia and sepsis.Methods: A retrospective analysis was performed on the data of 350 patients with community-acquired pneumonia and sepsis admitted to the Intensive care Unit of Third Xiangya Hospital of Central South University from January 2015 to October 2021.The basic characteristics,laboratory results,therapeutic drugs and mechanical ventilation methods were studied,and inflammatory factors were analyzed by matching healthy controls.Results: The majority of patients in both groups were male,and nearly half of the patients had the habit of smoking,and about 90% of the patients had the history of basic diseases,most of them had the history of recurrent respiratory tract infections,and the culture bacteria were mainly G-bacteria.The non-survival group of community-acquired pneumonia sepsis had a higher fever rate,and the absolute value of white blood cells,neutrophil ratio,neutrophil absolute value,inflammatory index,liver and kidney function,coagulation function,cardiac enzymology,lactic acid,and sequential organ failure evaluation score were also higher than those of the survival group.Tumor necrosis factor-α was higher in the community acquired pneumonia sepsis group than in the healthy control group,but interleukin-4 was the opposite.Logistics regression analysis showed that respiratory rate,heart rate,mean arterial pressure,blood oxygen saturation,C-reactive protein,D-dimer,lactic acid,creatinine and lymphocyte ratio may be independent risk factors for death at28 d.The receiver operating characteristic curve showed that the combination of the above indicators to predict the risk of patient death had the best sensitivity,specificity and maximum area under the curve,which was superior to the prediction value of single variable.Conclusions: Patients with g-bacterium infection with high fever and a history of recurrent respiratory tract infection are more likely to develop sepsis.Patients in the non-survivor group of community-acquired pneumonia sepsis had more severe inflammatory response and organ function impairment.Respiratory rate,heart rate,mean arterial pressure,blood oxygen saturation,C-reactive protein,D-dimer,lactic acid,creatinine,lymphocyte ratio and other indicators were independent risk factors for death at 28 d,and had better prognostic value when combined.